The major feature
of Factitious Disorder by Proxy is the deliberate production or feigning
of physical or psychological symptoms in another person who is under
that individual's care. The motive for the perpetrator's behavior
is thought to be a psychological need to assume the sick role by proxy.
External incentives such as money are not present. The perpetrator
simulates the illness in the victim and then takes the victim for
medical care while denying any knowledge about the cause of the problem.
The type and severity depend on the amount of medical knowledge on
the part of the perpetrator. Some of the signs of Factitious Disorder
by Proxy are:
Life stressors such as martial conflict;
Perpetrators
may exhibit pathological lying in describing daily events and when
presenting the victim for medical care.
Commonly
have knowledge in health related areas and may thrive in a medical
environment.
They often
seem insufficiently concerned about the victim's medical condition.
Associated
Features:
Equal distribution
between males and females.
High incidence of unexplained sibling mortality.
Disorder may be present in more than one child at a time, or serially
enmeshed family with marital dysfunction, substance and sexual abuse
Older children may engage in symptom collusion
Differential
Diagnosis:
Some disorders have similar symptoms. The clinician, therefore, in
his diagnostic attempt, has to differentiate against the following
disorders which need to be ruled out to establish a precise diagnosis.
The perpetrator
may become depressed or suicidal when confronted with consequences
of their behavior. The perpetrator usually focuses on one victim at
a time; however, other individuals may have been or might be victims.
Other aspects to be considered are:
Real Medical
illnesses
Overanxious Parenting
Normal Variability between illnesses
Illnesses resulting from discontinuation of medicines
Malingering (by an older child)
Cause:
Little is currently
known about the etiology or psychopathology of factitious disorders
with physical or psychological symptoms. Besides the difficulties
involving the diagnosis, reluctance of those patients to undergone
psychological testing and heterogeneity in details of cases published
in literature are at the origin of this situation.
Many hypotheses have been developed try to explain factitious disorder.
Some clinicians have remarked that patients with factitious disorder
often present traumatic events particularly abuse and deprivation
and numerous hospitalizations in childhood and as adults lack support
from relatives and/or friends. Others
consider that factitious disorder allows patients to feel in control
as they never felt in childhood.
From a behavioral point of view factitious disorder is regarded as
a coping mechanism, learned and reinforced in childhood.
Treatment:
Provide medical
and psychological care as needed to treat comorbid conditions and
complications arising.
Counseling
and Psychotherapy [ See
Therapy Section ]:
Psychotherapy
should focus on establishing and maintaining a relationship with the
patient. Supportive psychotherapy may help contain the symptoms of
FD. Family therapy may help families to better understand patients
and their need for attention. Cognitive-behavioral therapy may prove
difficult when patients are unable to form a collaborative team, such
as with comorbid antisocial personality disorder.
Pharmacotherapy
[ See Psychopharmacology
Section ] :
No medications
are shown to be efficacious in treating FD per se. However, pharmacologic
therapy for concurrent psychiatric diagnoses is indicated. When Pharmacotherapy
is applied it must be monitored carefully to prevent patients from
perpetuating self-destructive behavior. Medications to treat the symptoms
of personality disorders, such as selective serotonin reuptake inhibitors
(SSRIs) to reduce impulsivity, may be of benefit.
